Prolotherapy

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Prolotherapy ("Proliferative Injection Therapy"), sometimes referred to as sclerotherapy, involves injecting an irritant solution into the body, generally in the region of tendons or ligaments. Its proponents say it treats weakness in connective tissue and alleviates musculoskeletal pain. In the treatment of low back pain, prolotherapy injections are often combined with manipulation, exercises and injections into tender muscles.[1]

A helpful distinction is to apply the name "sclerotherapy" to the use of such injections (or laser interventions) in dermatology, where they are standard procedure for removing varicose veins and other irregularities, while reserving the name "prolotherapy" for the use of such injections in the treatment of connective tissue weakness and musculoskeletal pain. However, both names and "reconstructive therapy" are in common use for non-dermatological applications.

An evidence-based medicine review of prolotherapy for low back pain concluded: If used alone, prolotherapy injections do not have a role in the treatment of chronic low-back pain. When combined with other treatments, they may give prolonged partial relief of pain and disability.[2] Both Medicare and a variety of insurance companies (see, for example, Aetna.com) have so far found "insufficient scientific evidence" verifying either its safety or efficacy.

Contents

[edit] Prolotherapy in clinical practice

Prolotherapy involves the injection of an irritant solution into the area where ligaments have either been weakened or damaged through injury or strain. There are many solutions including Dextrose, Lidocaine (a local commonly used anesthetic), Phenol (an alcohol), Glycerine, or Cod Liver Oil extract. The injection is given into joint capsules or where tendon connects to bone. Many points may require injection. The injection, it is suggested, causes the body to heal itself through the process of inflammation and repair. In the case of weakened or torn fibrous tissue, inflammation and growth factor release induced at the site of injury may result in a 30-40% strengthening of the attachment points, although strong scientific evidence supporting this is lacking.

Prolotherapy treatment sessions are generally given every two to six weeks, allegedly to allow time for the growth of the new connective tissue.

[edit] History of Prolotherapy

Injections of irritant solutions were performed in the late 1800’s to repair hernias and in the early 1900’s for jaw pain due to temporomandibular (jaw) joint laxity. Dr. George Hackett, MD developed the technique of prolotherapy in the 1940’s.

[edit] Guidelines used by practitioners as indicators for prolotherapy

  • Recurrent swelling or fullness involving a joint or muscular region
  • Popping, clicking, grinding, or catching sensations with movement
  • A sensation of the “leg giving way” with associated back pain
  • Temporary benefit from chiropractic manipulation or manual mobilization that fails to ultimately resolve the pain
  • Distinct tender points and “jump signs” along the bone at tendon or ligament attachments
  • Numbness, tingling, aching, or burning, referred into an upper or lower extremity
  • Recurrent headache, face pain, jaw pain, ear pain
  • Chest pain with tenderness along the rib attachments on the spine or along the front of the chest
  • Spine pain that does not respond to surgery, or whose origin is not clear or consistent based on extensive studies

[edit] Scientific research

The Cochrane Collaboration, a group of evidence-based medicine (EBM) reviewers, reviewed four controlled trials on the use of prolotherapy injections for treating low back pain that had lasted for longer than three months. The reviewers concluded:

"There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low-back pain. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions. There was no evidence that prolotherapy injections alone were more effective than control injections alone. However, in the presence of co-interventions, prolotherapy injections were more effective than control injections, more so when both injections and co-interventions were controlled concurrently."[3]

Cochrane reviewers also stated that "[m]inor side effects from the treatment, such as increased back pain and stiffness, were common but short-lived."

Swedish researchers report that sclerotherapy/prolotherapy was effective in the treatment of Achilles tendinopathy in small clinical trials (Hakan Alfredson and Lars Ohberg, Br J Sports Med 2002:36:173-177; Knee Surg Sports Traumatol Arthrosc 2005:13:338-344). Diagnostic ultrasound showed that neovascularization and the presumably accompanying nerves were closely linked to pain in tendinopathy. When the blood vessels and nerves were removed with 1-4 injections of Polidocanol in a cross-over study, 19 of 20 subjects experienced successful resolution of their tendinopathy. Neovascularization in Achilles tendinopathy resembles the indications for sclerotherapy in dermatology, which suggests the possibility that musculoskeletal pain in other locations involving neovascularization and accompanying innervation might be effectively treated in this manner.

[edit] Criticism

The medical community does not generally recognize the efficacy of prolotherapy, in part because of a lack of extensive controlled studies of the treatment. Most major medical insurance policies do not cover the treatment.

[edit] See also

Minimally invasive procedure

[edit] External links

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